Married applicants may apply for a separate account. If you
are applying for Individual Credit, you must complete the Applicant
section about yourself and the Joint Applicant section about your
spouse if:

Your spouse will use the account, or

You are relying on your spouse's income as a basis for repayment.

If you are applying for Joint Credit with another person, complete
the Applicant and Joint Applicant sections.

1. Member Number

You must be a RESOURCES Federal Credit Union member to apply for a
loan.

2 .Type And Amount Of Credit You're Requesting

2.1 - Is this your first loan
from us?

Yes
No

2.2 - Amount/Credit Limit Requested:

$

2.3 - Approximate Time to Repay:

How Many:
Periods:

2.4 - Loan Type:

2.5 - Purpose of loan:

2.6 - Security Offered:

(for secured credit only)

2.7 - Are you submitting individually or
jointly?

3. Payment Protection Coverage

Check If Desired

Find out more about Payment Protection Insurance and why it's
a better consumer value when offered through your credit union.

Check coverage(s) desired. We will disclose the cost of this
Payment Protection Insurance - Credit Disability and Credit Life
- to you. A separate enrollment form which discloses the terms
and conditions must be signed for coverage to become effective.

Yes - Do you want your loan protected for you and your family
if you become disabled?
No

(You do not need to provide information
about alimony, child support, separate maintenance or other sources
of income if you do not wish to have them considered as income.)

7.6 - Salary:

$
.00

7.7 - How many hours are you scheduled to work a week?

Previous employer if less than 2 years:

7.8 - Name:

7.9 - Phone:

ext.

555-555-5555

7.10 - Other income:

$
.00

7.10a - Source of income:

8. Debts & Assets

8.1 - Please tell us about your
assets:

8.1a - List Financial Institutions,
Savings & Checking:

8.2 - Please tell us about your debts:

Lender

Type

Balance

Min. Pmt.

$
.00

$
.00

$
.00

$
.00

$
.00

$
.00

$
.00

$
.00

$
.00

$
.00

$
.00

$
.00

$
.00

$
.00

$
.00

$
.00

$
.00

$
.00

8.3 - Have you ever filed for bankruptcy?

8.3a - Has this bankruptcy been discharged
over four years ago?

8.3b - (If less than four years) What year
was the bankruptcy discharged?

8.4 - Are you co-maker/endorser on any loan not listed
above?

8.4a - If yes then for whom?

8.4b - If yes then to whom?

8.5 - Are you a U.S. citizen or permanent
resident alien?

9. References

9.1 - Nearest Relative NOT Living with you:

9.1a - Name:

First:

Middle:

Last:

Suffix:

9.1b - Home Phone
Number:

555-555-5555

9.1c - What is their home address?

Street:

City:

State:

Zip:

9.1d - What is the relationship?

You agree that everything stated in this application
is correct to the best of your knowledge. The Credit Union is authorized
to investigate your creditworthiness, employment history, and to obtain
a credit report and to answer questions about their credit experience
with you. You understand that any false or misleading statement in
your application may cause any loan or extension of credit to be in
default.

Note: A current wage stub
showing year-to-date information, or other income documentation will
be required for loan processing. Please fax this to (804) 281-6274 after
submitting your loan application.

By pressing the "Submit Application" button below, you
agree to the above statement. You understand that we may require your
signature on additional documents prior to disbursing any credit proceeds.